Sunday, February 1, 2015

Whiteness and the Anti-Vaccination Movement

Last week, Larry Wilmore addressed the anti-vaccination controversy on his new and well-regarded Comedy Central vehicle, The Nightly Show. Predictably, he lampooned famous "anti-vaxxers" such as Jenny McCarthy and her now-discredited guru Andrew Wakefield. Perhaps the most effective part of the segment was Melinda Gates talking about how attitudes toward vaccines are a cultural and economic phenomenon. "We take vaccines so for granted in the United States," Gates began. "Women in the developing world know the power of these. They will walk ten kilometers in the heat with their child and line up to get a vaccine because they have seen death." Wilmore, who is black, followed by implying that the fear of vaccines is a "first world problem." I was expecting Wilmore, whose race the entertainment media have made an emblem of The Nightly Show, to drill down a bit further and at least crack a joke about the color of this first world problem. But he didn't and, at least for now, the criticism of the anti-vaccination movement remains squarely within the discourse of social class. In this blog entry I would like to suggest that there is a strong racial element to the anti-vaccination movement. With each new story on the measles, I am left to wonder, "Why aren't people talking about the outbreak as having something, maybe a lot, to do with race?"

People of color have been long associated with disease and public health pandemics. In the United States alone, the history of racialization cannot be separated from the discourse of non-white bodily or mental illness. Although the experiences of immigrants from Asia and Eastern and Southern Europe are vital to this story, I would like to focus on one group in particular, black Americans, and the influential story told about them by a single man, Frederick L. Hoffman. Hoffman was an actuary for the Prudential Life Insurance Company when he published Race Traits and Tendencies of the American Negro (1896). The 330-page document argued that black people should not be insured because they were a greater risk for mortality compared to other racial groups. Their lower life expectancies were directly related, Hoffman explained, to inferior, inherited racial traits which promised their eventual extinction as a people. Flawed as it was and critiqued by no less than W.E.B. DuBois in its day, Hoffman's diagnosis was widely adopted by the insurance industry and went on to shape public debate over the "Negro question," according to Megan Wolff. It indicted blackness itself as the pathology, uncompromisingly predicting that no course of social uplift could alter the ultimate fate of the race. Race Traits stoked white fears of a black infirmity that threatened with contagion and miscegenation, social ills that were one and the same. By 1915, influenced by the burgeoning eugenics movement, twenty-eight states had passed anti-miscegenation laws; published a year later, Madison Grant's The Passing of the Great Race (1916) marked the age indelibly enough to find mention in The Great Gatsby. Blackness was, quite simply, a public health problem.

In the years following, the dominant notion of racial identity transitioned from one determined by genetics to one determined by culture. As eugenics lost its scientific authority, new discourses picked up its mantle to explain why black people were still at the bottom of the social ladder. Conservative voices increasingly portrayed black culture as pathological, focusing on high rates of public assistance, illegal drug use, out-of-wedlock births, and more. As readers of this blog might expect, my method to answer the question of racial disparities in these metrics would be to investigate the impacts of institutionalized white supremacy rather than those of a mythical monolithic black culture. But what about another kind of drug use, vaccinations? To what extent are attitudes toward vaccinations racialized, and what is their relationship to institutionalized white supremacy? The controversy over vaccinations can teach us a lot about the nature of whiteness.

Researching this entry, I contacted Dr. Jason Glanz, an epidemiologist at Kaiser Permanente Colorado's Institute for Health Research. Glanz has been researching vaccine usage for years, and he provided me with a number of studies breaking down the demographics of vaccine usage across multiple characteristics, including race. Glanz's own 2013 study, "A Mixed Methods Study of Parental Vaccine Decision Making and Parent-Provider Trust," for which he is the principal investigator, arrived at these findings, relevant to our question:
Parents who had either refused or delayed vaccines for their children were more likely to be white than parents who accepted vaccines for their children (P = .0003). Parents who delayed vaccines had the highest proportion of households earning $70,000 or more per year (71%), followed by parents who accepted vaccines (61%) and parents who refused vaccines (51%) (P = .002). (484)
A 2011 study, published in Pediatrics: Official Journal of the American Academy of Pediatrics, reported that "In bivariate analyses, levels of use of any type of alternative vaccination schedule were significantly lower among black parents than among nonblack parents and were significantly higher among children who did not have a regular health care provider" (851). I have not been able to locate a vaccination study whose research question plumbs the significance of race. However, these recent findings provoked me to ask why whiteness and high social status are significant factors in underimmunization or delayed immunization.

One of the reasons why we are not talking about the anti-vaccination movement as white is because we talk about geography and social class instead. These demographic characteristics often stand in as proxies for race, which is more controverisal. A 2015 study of vaccine usage, also published in Pediatrics, surveyed Northern California communities and came to the conclusion that "Underimmunization and vaccine refusal cluster geographically," and that "individual-level underimmunization was higher in neighborhoods with more families in poverty, as well as those with more graduate degrees" (285, 287). Geographic space in this country has always been racialized, the legacy of the FHA and redlining, urban renewal and white flight, sundown towns, and more. Words and terms such as "suburbia," "inner-city," and "gentrified neighborhood" tend to signify the skin color of the imagined inhabitants of those areas more than the areas themselves. The demographics of geographic space cannot be solely a function of social class, even and especially today when de facto practices of racial segregation may be even more effective than the de jure discrimination allowed before the 1968 Fair Housing Act. However, racialized space by itself does not fully explain what, exactly, whiteness has to do with refusing to vaccinate your children.

The anti-vaccination movement is a good model to illustrate an important critical race theory concept known as "whiteness as property." In her 1993 Harvard Law Review article "Whiteness as Property," Cheryl Harris explains that beyond a skin color, beyond even a race, whiteness in the United States is a form of property whose "use" is protected under the law. Property need not be tangible, explains Harris.
"Property is nothing but the basis of expectation," according to Bentham, "consist[ing] in an established expectation, in the persuasion of being able to draw such and such advantage from the thing possessed." [. . .] In a society structured on racial subordination, white privilege became an expectation and, to apply Margaret Radin's concept, whiteness became the quintessential property for personhood. [. . .] When the law recognizes, either implicitly or explicitly, the settled expectations of whites built on the privileges and benefits produced by white supremacy, it acknowledges and reinforces a property interest in whiteness that reproduces Black subordination. (1729-1731)
An analogy may help here. A medical or law degree is not tangible property, but it is property (just ask anyone who has one and has been part of a nasty divorce settlement). It is property because it is the basis for expectations in life that the law recognizes (e.g., the kinds of jobs you can have). Harris argues that whiteness, like one of these degrees, is a property interest, and its acknowledgement as such by the law--explicitly until 1968--is what makes whiteness so powerful. Whiteness, too, has a lot to do with the kind of job you can expect to have and claim. A long, racist history attends these "settled expectations," whose present nature cannot escape the influence of centuries of legal, institutionalized white supremacy. Following Harris, I argue that the expectations of white people with regard to immunizations are upheld by the law and by those who administer enforcement policy. What, then, are these expectations and these laws?

Even in just the past half-century, we can find ample evidence of the law honoring the preferences of middle-class white parents when it comes to the interests of their children vis-à-vis education policy. Take the example of Milliken v. Bradley, a 1974 Supreme Court case that ruled that desegregation busing could apply only to those school districts whose segregation practices could be proven as deliberate. Like busing policy, immunization policy also regulates which students can go to school and where. The ease with which parents receive immunization exemptions, particularly in certain states, represents the satisfaction of their settled expectations of how state and local authorities should treat their children. Historically, parents of color--black parents in particular--have had far less success advocating for their interests when it comes to the treatment of their school-aged children. Their battles for an integrated learning experience, teasingly promised by Brown v. Board of Education of Topeka, were thwarted by Milliken v. Bradley, which facilitated "white flight" to suburban districts exempted from integrating inner-city schools. Parents of color have had minimal success eliminating bias from the informal and formal curricular tracking of their children, which begins as early as kindergarten. And what is the relationship between racism and Louisiana's policy that those on public assistance may not claim a philosophic exemption? Or between racism and the fact that the state with the highest child vaccination rate--because it allows almost no exemptions for immunization, not even those of a religious nature--is Mississippi?

Some communities in California have exemption rates 700-800 times that of Mississippi. Gary Baum, the writer of this 2014 article for The Hollywood Reporter, claims that in this regard, affluent communities around L.A. are "on par with South Sudan." Westside L.A. parents, many of them employed in the entertainment industry, file "personal belief exemptions" (PBEs) at levels wildly disproportionate to that of L.A. County as a whole. According to Baum,
The number of PBEs being filed is scary. The region stretching from Malibu south to Marina del Rey and inland as far as La Cienega Boulevard (and including Santa Monica, Pacific Palisades, Brentwood, West Hollywood and Beverly Hills) averaged a 9.1 percent PBE level among preschoolers for the 2013-14 school year--a 26 percent jump from two years earlier. By comparison, L.A. County at large measured 2.2 percent in that period.
Lax California state requirements for PBEs and accommodating school administrators, Baum suggests, have combined to create extremely dangerous levels of underimmunization at some schools. Baum quotes a director of a school with a 30 percent PBE level who explains that "It's about respecting the parents. [. . .] I am personally concerned--my grandchildren are immunized--but that is not the issue. The issue is honoring the parents' belief." By respecting alternate immunization schedules, even some doctors accede to parents' "entitled" consumer mentality because they are paid in cash, says Dr. Nina Shapiro, director of pediatric otolaryngology at UCLA's Geffen School of Medicine.

There is a distinct Libertarian strain in the anti-vaccination movement. (Measles should be a regular topic for primary-season debates.) More than its uncooked link to autism, the CDC-recommended immunization schedule is unpopular with some parents because its prescriptive nature runs counter to a way of life that they see as different from and even superior to that of the vast majority of Americans. We can understand this position by examining attitudes toward "herd immunity." Herd immunity is a widely-accepted public health theory that holds that the innoculation of a critical mass of the members of a community can protect those who have not developed an immunity to the disease. Anti-vaccination parents depend on herd immunity to protect their children but see themselves apart from the herd mentality. Baum interviewed Dr. Mark Largent, a historian of science, technology, and medicine at Michigan State University, on the relationship between privilege and herd immunity.
Largent observes that herd immunity isn't a convincing argument in modern societies like the Westside. "For [these people], what you’re saying is that the public good is more important than their child's well-being," he says. "I don't think parents give a shit. It doesn't work for them. It's such a big, amorphous claim."
Given how the decision to vaccinate has entered the discourse of rights, developing signs of becoming a partisan political issue, it's conceivable that vaccinations may soon be criticized as a kind of unjust tax.

I admit that I am neither a scientist nor a public health professional. Like my other blog entries, this one merely proposes that institutional racism shapes our relationships with one another in crucial but often unseen ways. To what extent is the anti-authoritarian and Whole Foods way of life within these mostly-white L.A. enclaves enabled and normalized by residential and educational segregation, access to employment in the lucrative film industry, and the very real option of full-timing it as an engaged and well-read parent? It is important to note that the most visible opponents of the anti-vaccination movement are also white. Outraged by the ignorant irresponsibility of "anti-vaxxers," these "anti-anti-vaxxers" are also responding to their settled expectations of freedom from disease not being upheld by the state (surely a racialized expectation given the state of our health care system), leading them to demand new laws, stricter regulations for PBEs, and official censure for non-complying physicians.

Blackness has long been perceived as a public health threat, as the recent hysteria over Ebola has demonstrated. I believe that whiteness--not white people in and of themselves, to be clear--as defined by Harris, the settled expectations of white privilege as protected by law, is contributing to a new public health threat. A productive way to understand whiteness as property is to try to think of ways that black Americans' settled expectations for life, liberty, and happiness are not codified in the law. Whose expectations are served by policies such as "broken windows" and "stop-and-frisk"? Or by the Bloomington city attorney bringing charges against Mall of America protesters? If the measles and whooping cough outbreaks get massive media attention partly because of their potential impact on white communities (compared to the Ebola virus before it crossed the Atlantic), then we might also investigate whiteness as part of the cause, a call to research that I hope this blog will sound. Whiteness as property is only one way to imagine the intersection of race with class when considering how power animates public health emergencies such as the measles outbreak.

Back to the subject of taxes, whiteness as property can also help with the analysis of other social crises, including the fiscal fallout of California's Proposition 13, a landmark 1978 referendum that, among other things, froze personal and commercial property taxes at 1975 levels until the property is sold or rebuilt. Critics of the law have claimed that it is "responsible for causing a fiscal and social disaster" in California since its passage. Others have called out the institutional racism of the law, which allows long-time, established owners of valuable homes and businesses, most of them white, to pay less than their fair share in taxes. These Californians of an older era, residents before recent immigration changed the complexion of the state, might be considered part of another herd. While the owner of a new Santa Monica home is taxed between five and ten dollars per square foot, one venerable California institution that hasn't ever changed hands pays about a nickel per square foot. The institution? Disneyland.


  1. This is nothing short but a piece of presumptive garbage.
    Trying to pin-point a basic "racial" reason for persons who are un-moveable in their decision NOT to allow their children to get vaccinated is just despicable liberal minded reasoning.
    I grew up as a child with measles, chicken-pox, and survived them all. I also as an adult also suffered "shingles" on two occasions, due to having measles as a child.

    We live in a world where all sickness and diseases must end, especially to children. Human life has always known sickness, and death that is all part of life. We are trying to run away from suffering, but you know what, suffering is part of life that will NEVER end, until this earth passes away.

    I did not come from a "wealthy" family, matter of fact lower middle class, "if" that!
    I as one do not trust any government, scientist, doctor, nor liberal minded so-called Philosopher that will "force" me to chose a "medical" method, that I know is dangerous to MY LIFE.

    Persons like you are the cowards, you manipulate society to think as you do, and most do, but it's simply the "blind leading the blind" mentality. Persons of your nature can't STAND independent thinkers, and persons who will NOT trust the status-quo and their so called "good will" for the "good" of mankind!

    This type of writing along with the mentality that stands behind it, is the danger that Ayn Rand in Atlas Shrugged tried to warn society about.

    1. Shingles is caused by the same virus as chickenpox, not measles.

    2. Thank you for the correction, that's the first I have ever heard it was caused due to chickenpox. Nevertheless I survived, and still I will not allow any form of Vaccine to enter my body for any reason.
      I'm so grateful that I don't have children which would have to live in such a world as we live in now. For the freedom of choice seems to be only exceptable by the liberal mindset when it comes to their freedoms, such as abortion.
      God will judge this world for it's abominations!

  2. Excellent piece. As a Black woman pediatrician who has practiced in both urban and rural parts of California I am familiar with the characteristics of parents who choose to be "vaccine flexible" (alter the vaccine schedule) or choose no vaccines for their children. I currently live in a county (Sonoma) that has the second lowest vaccination rate in the state (north of Marin).
    White privilege is a critical component that many have overlooked in addressing the resurgence of vaccine-preventable disease in industrialized countries. Non-adherence to a vaccine schedule has not been viewed as a health disparity. I wonder how differently this measles outbreak would be viewed if the non-vaccinating parents were Black or Brown. Pierrette Mimi Poinsett MD

    1. You make a good point about race and ethnicity of anti-vaccers. I think it is fare to say that different cultures look at health and medicine differently so would it also be fare to say that perhaps there lies a difference in the ethnic or racial background between those who choose to vaccinate their kids and those who done? Though there has been no solid evidence of this I don't think it should be overlooked. I also agree with the statement that peoples perspective on vaccines have a lot to do with what region of the world they are living it. It may be true that people in first worlds take more of a lax or optional view on vaccines while those in third world view them as life saving medicine.

  3. You might be interested in a piece by Jennifer Reich, a sociologist, who interviewed vaccine schedule altering and anti-vax parents. 24/25 were white, in Colorado, relatively educated/higher income. Reich argues that these mothers are influenced by neoliberal cultural frames...and that mothers see themselves as experts in their children's health, see risks of vaccination as greater than risks of not vaccinating, and see themselves as able to control disease risk through kinds of "imagined gated communities." Interesting piece, and it addresses what you're asking.